Lifesaving test for childhood cancer gets boost in funding

A lifesaving test which gives advance warning of leukaemia relapse in children has received a further cash injection of £1.7 million thanks to leading blood cancer charity, Leukaemia Research (LRF).

A lifesaving test which gives advance warning of leukaemia relapse in children has today (Thursday 30 March 2006) received a further cash injection of £1.7 million thanks to leading blood cancer charity, Leukaemia Research (LRF).

The test, which is the centrepiece of a major trial in the UK, ensures the accurate detection of minute numbers of leukaemia cells (minimal residual disease - or MRD) that remain after treatment but cannot be detected under the microscope.

The MRD test has been part of the national childhood leukaemia trial (UKALL 2003) for the past three years and has been enabling doctors to select which patients are at high risk of relapse and which children could actually be cured with significantly less chemotherapy.

During the course of the trial, which runs from 2003 to 2009, more then 2,000 children diagnosed with leukaemia will be tested for levels of MRD.

Dr Nick Goulden, one of the UK’s leading leukaemia experts from Bristol Royal Hospital for Children and the University of Bristol, who is coordinating this trial, welcomed today’s news.

“Up until a few years ago the only way to monitor a child's response to treatment has been to look down a microscope for leukaemia cells in blood or bone marrow samples. This is an incredibly insensitive ‘steam age’ method,” he says.

“MRD monitoring has revolutionised the way we assess a child’s response to leukaemia treatment. It is now possible to much more accurately determine the best therapy for an individual child with acute lymphoblastic leukaemia, ” adds Dr Goulden.

Forty years ago, less than 5 per cent of the 450 children diagnosed each year with this type of leukaemia were cured, even after they had received several years of treatment. By the late1990s this figure was approaching 75 per cent due to the use of more intensive chemotherapy. Today, thanks to the MRD testing programme, over 80 per cent of children are now surviving and going on to lead healthy lives.

“Progress over the past three years of the trial has been promising,” says Dr Goulden. “Recruitment to the trial is good and at the moment our results and those of other international studies suggest that MRD based therapy will be successful.”

Every child treated for leukaemia will have some residual leukaemia cells in their bone marrow after their first month of chemotherapy - known as induction treatment. This level may fluctuate between 1 in 20 cells to less than 1 in 10,000 cells. Until now, the problem has been that conventional techniques (under the microscope) are not able to accurately measure the levels of these cells.

Children entered into this national childhood leukaemia trial are tested for minimal residual disease at the end of their induction treatment (day 28).

Samples of bone marrow are sent to one of the four MRD laboratories - Bristol, Glasgow, London or Sheffield - for MRD monitoring. Depending on the level of disease, the patients are then put into one of two treatment arms.

Dr David Grant, Scientific Director at Leukaemia Research says: “The MRD test allows doctors to treat children with leukaemia in a far more informed and controlled way. It brings real hope to children and their families, and helps us strive to reach our final goal of 100 per cent survival.“

When a child is diagnosed with leukaemia, their life is turned upside down overnight. Together with their family, their lives begin to revolve around the hospital for months and even years.

In addition to the physical side effects of treatment, nausea, hair loss and stomach problems, there are many other issues, which arise from this treatment - resulting from time out of school, and lengthy periods away from friends. The impact of this should not be underestimated.

“For a child with low risk MRD, we are testing whether it is now possible to reduce the amount of time they spend in hospital,” says Dr Goulden. "This represents a major improvement in quality of life - and a step closer to our goal - cure with the minimum of disruption,” he adds.

This latest cash boost will support the use of the test for a further three years until the end of the trial in March 2009, at which time it is hoped it will become part of standard NHS treatment. As well as saving more lives, leading leukaemia scientists also believe MRD monitoring could have substantial cost-saving implications for the NHS.

“We believe a reduction in the risk relapse will lead to substantially fewer bone marrow transplants - as many as 15-20 transplants a year - which cost up to £100,000 each,” says Dr Goulden.

“Less chemotherapy for low-risk children will also reduce the cost of treatment dramatically,” he adds.

Over the next five years, Leukaemia Research urgently needs raise over £100million to commit to new research across the UK. From basic laboratory research to clinical trials with patients, Leukaemia Research is committed to saving lives by funding high quality, carefully selected research throughout the UK.

Leukaemia Research is the only national charity devoted exclusively to improving treatments, finding cures and learning how to prevent leukaemia, Hodgkin’s lymphoma and other lymphomas, myeloma and the related blood disorders, diagnosed in 24,500 people in the UK every year. Further information, including patient information booklets, is available from www.lrf.org.uk